The course of accidental epidural morphine overdose without naloxone: A case report

Authors: Lu, Hsiao-Feng; Cheng, Kwok Wai; Luk, Hsiang-Ning; Chang, Kenneth Kwok-Ang; Lin, Kun-Chen; Jawan, Bruno

Source: The Pain Clinic, Volume 16, Number 3, 2004 , pp. 359-362(4)

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Abstract:

Background : Naloxone is a morphine antagonist usually given to reverse or to prevent the respiratory depression induced by morphine overdose.

Case presentation : A 61-year-old man underwent a lower abdominal resection for rectal carcinoma. Epidural morphine 2 mg diluted in 10 ml of normal saline was prescribed. Twenty milligrams of morphine instead of 2 mg morphine were given by mistake. The patient was intensively observed in the post-anaesthetic room without giving naloxone for 40 hours. The respiratory rate and arterial blood gases were monitored. The respiratory rate was mildly depressed (below 16 breaths/min) for as long as 20 hours. The peak of the respiratory depression was observed after 2–3 hours with a respiratory rate of 12 breaths per minute and P_aCO₂ of 56.3 mmHg. The patient was almost 40 hours pain free. No nausea, vomiting and pruritus was noted, but urine retention was observed for 26 days.

Keywords: NALOXONE; OVERDOSE; RESPIRATORY DEPRESSION; EPIDURAL MORPHINE; URINARY RETENTION

Document Type: Regular Paper

DOI: http://dx.doi.org/10.1163/1568569041798290

Publication date: 2004-08-01

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